Former patients aid search for missing TB cases in DRC province

In the South Kivu province of the Democratic Republic of the Congo, where the impacts of military conflict fuel the spread of disease while challenging health service access, obstacles to finding undiagnosed people sick with — and at risk of transmitting — tuberculosis are matched only by the urgency to do so.

While the World Health Organization estimates that active tuberculosis in about a third of the estimated 10 million people who became sick with the disease in 2016 went undetected, unreported, likely untreated, and, thus, transmitted, the proportion of missing TB cases in resource-limited countries that include the DRC is even higher — more than half of all cases.

This week, as WHO documents conditions complicating responses to a new Ebola outbreak in the neighboring North Kivu province, a report from the agency describes how enlisting former tuberculosis patients and their family members in a nonprofit focused on screening people at high risk for the disease and referring them for testing and treatment made a difference.

According to the report, released in the WHO Bulletin today, the nonprofit, Amassadeurs de Lutte Contre la Tuberculose, invited and trained former tuberculosis patients who formed volunteer groups of 1- to- 20 people in local clinic areas. Those groups in turn, organized screening efforts targeting those at highest risk — people living in a household with someone sick with the disease, as well as miners, prisoners, and military personnel and their families. The groups received $10 dollars a month for administrative and transportation costs, and the individual screeners received fifty cents for each person who showed up for testing.

Between 2014 and 2015, their work led to the diagnoses of an estimated additional 4,300 people sick with tuberculosis, whose illness might otherwise have been missed, untreated, and transmitted, representing more than 40 percent of the total number diagnosed during the period.

The cost of finding them was relatively low — about $44 per diagnosed patient — compared to the cost of the spread of tuberculosis. But, the authors caution, with funding for project running out, new grant funding may be difficult to secure by workers “not skilled in responding to highly competitive international grant calls.” They would benefit, the researchers add, from international support to publicize their work.